Please analyze this MRI result?

[ditterbo]

Anyone here familiar with reading MRIs?  There is literally a black hole in the middle of my chin in this MRI scan.  I'm hoping it's just the MRI rejecting the titanium screw and not missing muscle??  The x-ray cephs in the link below show the 18mm x 2.7 synthes screw used from the first chin implant.  The revision doctor said the screw stuck out "a mile high" over the first chin implant.  He cut 3mm off the top of it and secured a bigger implant on the same screw, but the screw no longer protrudes out of the implant. 

The striped shirt is with the new chin implant (also malpositioned wing on left side), and puma shirt is with the first chin implant.  Both are painful with their left wings out of pocket. I had this MRI done to find problems with my chin muscles that could be causing my center lower lip paralysis.  Like the center won't pull down at all when I smile and creates a flat lower lip affect instead \_/. 

I have consultations in July with a few max facs in CA but if my smile is perma botched, then there's no point for me to get bimax.  Whatever aesthetics I get out of it, if I can't smile naturally anymore then no cosmetic surgery can compensate for that and I'll never be at peace.  Even if I get a good bimax outcome, I can't get past the lower lip paralysis.

EDIT - I've gotten no help so far, so PM me if you want a link to pics.

[marcus3415]

Your smile is nice man, what are the main problems?

[ditterbo]

I updated the link with 3 new collages, but you'll need to zoom in on the 2nd one to focus in on the lips.  Other than the rhinoplasty adding all kinds of wrinkles around my eyes, making me look like way more than 1.5 years have passed between shots, my upper and lower lips don't work the same anymore. 

The upper lip thins out, which is probably because of the columella strut graft.  If/when I get my tip revised, I'll ask to remove it. 

The lower lip is frozen 'at rest' for about an inch in the very center.  If I don't smile very widely, it's much more subtle but it is always there if you pay close attention to the contour and compare to pre op smiles, which had a  uniformly wide U shape.  Now my wide smiles flatten out after the arches, which I never had before and sort of gives the affect like I'm smiling out of fear or uncertainty when you take in the overall affect it has on the face.  Hate it.

EDIT: I think this may at least partially be a marginal mandibular nerve injury?  The whole right half of the lower lip, culminating especially at the center, doesn't pull down as well as the left side.  Also, if I tense my whole chin, I can't really at all on my right side.  Thoughts??